PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Board of Chiropractic Examiners

Legislative

Current through July 31, 2017

If you wish to review any of the following Public Chapters in their entirety, please visit:
http://sos.tn.gov/division-publications/acts-and-resolutions.

Board Specific Updates:

Public Chapter 38

This sunset provision extends the board of chiropractic examiners until June 30, 2021.  

Public Chapter 163

This legislation revised several areas of the code in order to allow chiropractic physicians to enter into a direct primary care agreement with an individual patient or his or her legal representative.  This act took effect on April 24, 2017. 

Public Chapter 455

This act revised certain definitions related to the practice of chiropractic, as well as made several other revisions to code regarding the practice of chiropractic.  The practice of chiropractic is defined as the diagnosis and treatment of patients as further defined in law.  “Diagnosis” means:

The differential diagnosis of human ailments through examination and evaluation of patients and through diagnostic procedures necessary to clinically correlate a physical examination to a diagnostic impression; the ordering of X-rays, advanced diagnostic imaging, and other diagnostic procedures; the performance of X-rays and other non-invasive diagnostic procedures, as well as minimally invasive procedures that have been approved by the Board after consultation with the Board of Medical Examiners ('BME') and that the chiropractic physician has received training for; and the collection of blood, urine, saliva, and hair for analysis.

“Differential Diagnosis” means the examination of body systems and structures of a patient to determine the source, nature, and extent of a disease or other physical condition for purpose of establishing an appropriate plan of care for the patient, which may include referral to another provider for care that it outside the chiropractic physician’s scope of practice.

“Treatment” means:

The treatment of neuromuscular, musculoskeletal, and related conditions through the use of chiropractic adjustment and manipulation; physical agent modalities; manual, rehabilitative and other therapeutic care; and mechanical, chemical, electrical, and thermal methods.It also means the use of acupuncture after appropriate training; the location and removal of interference with nerve transmission and function; the ordering of durable medical equipment, and the provision of supportive care.

Additionally, this legislation raised the per diem for members of the board of chiropractic examiners from $50 to $100.  Finally, the legislation requires the board to adopt rules that establish minimum educational standards and criteria for chiropractic therapy assistants.  This act took effect on July 1, 2017. 

Public Chapter 350

This legislation will allow healthcare providers to satisfy one hour of continuing education requirements through the performance of one hour of voluntary provision of healthcare services.  The maximum amount of annual hours of continuing education that a provider can receive through providing volunteer healthcare services is the lesser of 8 hours or 20% of the provider’s annual continuing education requirement.  The legislation allows for rulemaking by the division of health related boards in order to administer this section.  This Act took effect on May 12, 2017.

Public Chapter 215

This legislation requires state governmental entities that establish or adopt guides to practice to do so through the promulgation of rules, rather than policy.  The rules so promulgated must specify all provisions included in and relating to the guide to practice.  Any changes to guides to practice made after the guides are adopted must also be promulgated by rule in order to be effective.   For purposes of this part, guides to practice includes codes of ethics and other quality standards, but does not include tests, examinations, building codes, safety codes, or drug standards.  This legislation took effect on April 28, 2017.

Public Chapter 240

This legislation authorizes entities that regulate health professionals to issue limited licenses and makes various changes related to reporting of disciplinary matters to licensure entities. This legislation will:

Insure the integrity of licensure examinations by making examination questions, answer sheets, scoring keys, and other examination data confidential and closed to public inspection.

Allow the issuance of limited licenses to applicants who have been out of clinical practice or inactive, or who are engaged in administrative practice.Limited licenses may be of restricted scope, restricted duration, and have additional conditions placed upon them in order to obtain full licensure.

Clarify that other documents prepared by or on behalf of the Department with regard to an investigation are confidential until such time as formal disciplinary charges are filed against the provider.

Eliminate the “locality rule” for administrative law.

Require the chief administrative official for each health care facility to report within 60 days any disciplinary action taken against an employee for matters related to ethics, incompetence or negligence, moral turpitude, or substance abuse, to the employee’s respective licensing board.All records pertaining to the disciplinary action shall be made available for examination to the licensing board.

This act became effective on May 2, 2017.

Public Chapter 481

This legislation creates a new violation of a healthcare practitioner’s practice act if that practitioner refuses to submit to or tests positive for any drug the practitioner does not have a lawful prescription for or a valid medical reason for using the drug.  It is the duty of the employer to report any violation to the Department of Health.  If the practitioner fails a drug test, the practitioner has 3 business days to either produce the requisite prescription or medical reason, or report to their board approved peer assistance program.  If the practitioner does not comply with any of these measures, it is the duty of the employer to report this violation of the practice act to the employee’s licensing board for investigation and action.  If the practitioner reports to the peer assistance program and obtains and maintains advocacy of the program, the employer is not required to notify the board. 

As long as a practitioner obtains, maintains and complies with the terms of a peer assistance program, the board shall not take action on the licensee for the sole reason of a failed or refused drug test.  If a practitioner fails to obtain or maintain advocacy from the peer assistance program, the program is required to report that information to the appropriate licensing board.  The board SHALL suspend the license of a practitioner who fails to comply with the terms of the program.  Employer drug testing must be compliant with the Drug-free Workplace requirements.  This legislation allows a quality improvement committee to share information regarding substance abuse by a practitioner with other quality improvement committees.  Additionally, this legislation specifies that the Department of Health is not required to obtain prior approval from the Attorney General in order to take any emergency action on a licensee. This legislation took effect on July 1, 2017.

Public Chapter 230

This legislation authorizes commissioners or supervising officials of departments to evaluate certain actions by a regulatory board to determine whether the action may constitute a potentially unreasonable restraint of trade.  Supervising officials must ensure that the actions of regulatory boards that displace competition are consistent with a clearly articulated state policy.  If a board action constitutes a potentially unreasonable restraint of free trade, the supervising official must conduct a further review of the action and either approve, remand or veto the action.  The supervising official may not be licensed by, participate in, or have a financial interest in the occupation, business or trade regulated by the board who is subject to further review, nor be a voting or ex officio member of the board.  The supervising official must provide written notice of any vetoed actions to the senate and house government operations committees. 

Prior to filing a regulatory board's rule with the secretary of state, the commissioner or chief executive officer of the administrative department under which a regulatory board operates or to which a regulatory board is administratively attached, or a designee to the extent a conflict of interest may exist with respect to the commissioner or chief executive officer, must remand a rule that may constitute a potentially unreasonable restraint of trade to the regulatory board for additional information, further proceedings, or modification, if the rule is not consistent with a clearly articulated state policy or law established by the general assembly with respect to the regulatory board.  This act took effect on April 24, 2017.    

Public Chapter 763

This Act permits licensees, whose licenses have expired due to non-payment, to be reinstated when payment of the annual (which is actually bi-annual) renewal fee along with payment of a late renewal fee that is capped at twice the annual renewal fee are completed. This public chapter makes no changes to continuing education requirements and all unattained continuing education must be completed along with repayment structure above prior to reinstatement. This replaces the current requirement of payment of all past due fees before reinstatement. This act took effect on July 1, 2016.

Public Chapter 990

This legislation requires an insurer to reimburse and provide coverage for telehealth services provided by a practitioner licensed in Tennessee, regardless of the patient's location. This act will take effect on January 1, 2017.

Public Chapter 1029

As enacted, amends the provisions governing X-ray equipment operators. This act will take effect on January 1, 2017.

Public Chapter 154

This act allows the Commissioner of Health or his designee to have electronic access to medical records in order to facilitate investigations when responding to an immediate threat to public health. Today the Commissioner of Health or his designee already has this authority but must go to the facility to review the medical records.  This act took effect on April 16, 2015.

Public Chapter 94

This act defines “abuse” and “neglect” for purposes of placing a person on the registry of persons who have abused, neglected, or misappropriated the property of vulnerable individuals specifically within the statutes that govern the Dept. of Health. It does not impact the definitions within the statutes that govern the Dept. of Intellectual and Developmental Disabilities nor the Dept. of Human Services.  It also increases the time within which placement on the registry may be appealed from 30 to 60 days.  For rulemaking purposes, this bill became effective on April 10, 2015.  All other provision become effective on July 1, 2015.

Public Chapter 502

This act allows the Joint Government Operations Committee (the legislative committee that reviews all rules) to stay a rule up to 75 days instead of 60 days.  Present law authorizes the Joint Government Operations Committee to consider the following factors when reviewing rules: authority, clarity, consistency, justification, necessity and reference. This act adds arbitrariness and capriciousness as two new considerations.

Public Chapter 268

This act makes disclosures of protected healthcare information permissible in medical malpractice lawsuits and became effective on April 24, 2015.

Public Chapter 121

This legislation would allow the Board of Chiropractic Examiners to petition a court to require a person to cease and desist in solicitation or telemarketing individuals after an accident or natural disaster.  This act took effect on July 1, 2015.

Public Chapter 261

The act provides for the practice of telehealth. It outlines the following:

  • Defines a healthcare provider
  • Establishes a provider-patient relationship by mutual consent and mutual communication
  • Specifies that telehealth does not create a new standard care
  • Prohibits any board from creating a more restrictive standard of professional practice for telehealth service
  • Allows a physician to prescribe by means of telemedicine and follow all prescribing applicable statutes such as checking the Controlled Substance Monitoring Database; however, pain management clinics are not permitted
  • There is no separate telehealth license required by the Bd of Medical Examiners

Public Chapter 475

  • Changes the requirements for who can become a certificate holder of a pain clinic. Certificate holders:
    • Must be a Tennessee licensed Medical Doctor, Doctor of Osteopathy, Advanced Practice Nurse or Physician’s Assistant and
    • This no longer allows pain clinics to be owned, in whole or in part, by chiropractors

 

Updates Applicable to All Boards

Public Chapter 949 This act allows for initial licensure applications to be accepted online. Currently, renewing licenses is already available online. This also makes available to the public annual inspections of health care facilities and pharmacies, similar to how nursing home inspections are already available.

Public Chapter 763 This act revises delinquent privilege tax provisions that would require the Department of Revenue to notify the licensee that failure to cure the delinquency or deficiency prior to their licensure renewal date can result in renewal abeyance. For purposes of the bill, “cure” means payment in full, entering into an agreed payment plan, or abatement of tax liability. Licensing boards will be provided monthly with list of licensees who are delinquent 90 days or more and boards may not process licensure renewal.

Public Chapter 675 The act allows telehealth providers to contract with insurance companies to have their services covered in offered plans. Insurance providers cannot deny payment solely because the encounter was not in person.

Public Chapter 575 This act extends civil immunity to health care providers providing services at clinics that charge patients based on a sliding scale to health care providers offering services at a clinic that does not charge a patient for services.